Maxillectomy

Overview 

A maxillectomy is a surgical procedure involving the partial or complete removal of the maxilla or the upper jaw. This is typically used for the treatment of specific head and neck malignancies.  

Some cases of maxillectomy involve removal of adjacent structures such as the teeth, palate, and orbital bones. Postoperatively, reconstructive surgery may be required to restore anatomical and functional integrity to the affected region.  

Types  

Various types of maxillectomy are available, and the choice of procedure depends on the tumor’s size and location.  

• Total maxillectomy 
• Partial or subtotal maxillectomy 
• Suprastructure maxillectomy 
• Medial maxillectomy 
• Infrastructure maxillectomy   

Reasons for undergoing the procedure  

Maxillectomy are suggested to treat certain conditions, such as:  

• Severe fungal sinus infections  
• Cancers that affect the maxilla, nose, roof of the mouth, or sinuses  
• Cancer has spread, parts of nearby structures like the eye, roof of the mouth, bones around the eye, nerves, teeth, or tear ducts  

Invasive fungal sinusitis, a serious condition caused by inhaling certain fungi, can lead to inflammation and tissue loss in the sinuses. 

Risk 

Similar to any surgical procedures, maxillectomy carries several risks, such as:  

• Epiphora, or excessive tearing
• Infection 
• Sagging of the lower eyelid
• Eustachian tube problems 
• Cheek numbness due to nerve injury 
• Excessive bleeding and bruising, or hematoma
• Formation of blood clots.  

Procedure 

Maxillectomy surgical options include:  

• Total maxillectomy: This surgery requires significant reconstruction and the use of prosthetic devices to restore function and appearance. It involves removal of the entire maxilla, hard palate, and orbital floor.  
• Subtotal (partial) maxillectomy: This procedure aims to preserve as much of the maxilla as possible while removing only the affected part, helping to maintain facial structure and function.  
• Suprastructure maxillectomy: Reconstruction is usually needed to repair the area, and if the eye is removed, a prosthetic can help maintain appearance, though it will not restore vision. The surgery removes the upper part of the maxilla and may include nearby structures like teeth, the orbital floor, the eye, tear duct, and nerves.  
• Medial maxillectomy: During the procedure, the healthcare provider either makes an incision on the side of the nose or uses an endoscope through the nostril to access the tumor. It removes the part of the maxilla closest to the nose and nearby teeth. This procedure usually does not need reconstruction.  
• Infrastructure maxillectomy: This procedure removes the lower part of the maxilla, including teeth and the hard palate, leaving a hole in the roof of the mouth. Tissue from another part of the body may be used to close the hole, or a prosthetic device may be needed to seal it.  

Additional procedures that may accompany a maxillectomy include the placement of a feeding tube to ensure proper nutrition, dacryocystorhinostomy to reroute tears if the tear ducts are involved, and neck dissection if there’s concern about cancer spreading to nearby lymph nodes. A tracheostomy might be necessary if swelling is expected to obstruct the airway, and reconstructive surgery may be required to restore facial features after the procedure. 

Outcome

During recovery period, it is important to monitor for signs of complications. Seek immediate medical assistance if any of the symptoms are experienced:  

• Pain that does not improve with medication 
• Signs of infection, such as fever 
• Unusual swelling  
• Trouble breathing 

Recovery time depends on the type of maxillectomy. Initial recovery may involve:  

• Oxygen support through a tracheostomy   
• Nutrition through a feeding tube extensive reconstruction.  
• Pain medications, clot and infection prevention   
• Up to two weeks in the hospital 

Medial maxillectomy is the least invasive with the fastest recovery, while infrastructure maxillectomy is more complex and takes longer.  

Suprastructure and total maxillectomies are the most invasive, requiring the longest hospital stays and home recovery.  

The healthcare provider may also provide guidance during recovery at home, such as:  

• Refrain from consuming hot foods and beverages, as some areas of their mouth may remain numb  
• Consume soft meals while the incision heals  
• Refrain from physically demanding activities  

While many individuals achieve successful healing, the removal of sections of the jaw and surrounding structures can make daily activities like eating and speaking difficult. Speech therapy can play a crucial role in improving these abilities. 

Recovery from a maxillectomy can be prolonged, often taking several months for individuals to fully regain their speaking and swallowing capabilities. However, if the surgery involves the removal of cancerous tissue, it significantly increases the chances of survival. 

Overall, the prognosis depends on the type and stage of head and neck cancer, with later-stage cancers generally associated with a poorer outlook.